SACRAMENTO – In a surprise move made in response to President Donald Trump’s push to repeal and replace the Affordable Care Act, two California lawmakers Friday introduced legislation to replace private medical insurance with a government health care system covering all 38 million Californians — including its undocumented residents.

“We’ve reached this pivotal moment and I thought to myself: ‘Look, now more than ever is the time to talk about universal health care,’” one of Senate Bill 562’s authors, Sen. Ricardo Lara, D-Bell Gardens, said in an interview Friday.

The Healthy California Act, co-authored by Sen. Toni Atkins, D-San Diego, was submitted just before the deadline for new legislation. It doesn’t yet offer many specifics other than the lawmakers’ intent: to create a so-called single-payer system that would pay for coverage for everyone.

Proponents argue that single-payer systems make health care more affordable and efficient because they eliminate the need for reams of paperwork, but opponents say they raise taxpayer costs and give government too much power.

Medicare, the federally funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.

The idea has periodically gained traction in the Golden State and elsewhere in the country. Vermont Sen. Bernie Sanders — who nearly toppled Democrat Hillary Clinton during last year’s presidential primary — widened its popular appeal on the left.

But while other developed nations have achieved universal coverage through single-payer plans, one has yet to get off the ground anywhere in the U.S.

Colorado voters overwhelmingly rejected a similar proposal last fall amid widespread concerns about the cost. Perhaps the best-known effort to create a single-payer plan was in Vermont, but it failed in 2014 after the state couldn’t figure out how to finance it.

The California Nurses Association is backing SB 562, which insurers will no doubt lobby heavily to kill.

Proponents argue that such plans are not as costly as they appear because new taxes would eliminate the soaring costs of insurance premiums. Boosters also contend that huge savings would come from eliminating the growing mountain of administrative costs — and high profits — of insurance companies.

“Quite frankly, we have to cut out the insurance company waste and duplication,” Lara said.

“Cut them out. They’re not good at it. They cause families like ours headaches. Just cut them out.”

Johnson, of Alameda, said she is deeply worried about the repeal of the Affordable Care Act, given the medical needs and pre-existing conditions of her daughter and others like her. Her only comfort in the wake of Trump’s election, she said, was the thought that state lawmakers would propose a single-payer plan.

But one longtime critic of single-payer plans, who moved to California from Canada in the early 1990s, said the national health care system in her country has led to increasingly long waits to see a doctor — and has driven many Canadians to come to the U.S. for medical treatment.

“It’s been a disaster in countries like Canada,” said Sally Pipes, president and CEO of the conservative Pacific Research Institute, based in San Francisco.

But data this week related to the stunning impact of the 2010 health care law, better known as Obamacare, may help single-payer advocates like Atkins and Lara.

The U.S. Centers for Disease Control and Prevention reported that California’s uninsured rate dropped from 17 percent in 2013 to 7.1 percent in 2016, a record low for the state. The national uninsured rate is at an all-time low of 8.8 percent, down from 14.4 percent in 2013.

“In light of threats to the Affordable Care Act,” Atkins said in a prepared statement, “it’s important that we are looking at all options to continue to expand and maintain access to health care. The Healthy California Act is an essential part of that conversation.”

The senators said in a statement that their vision of the bill will be outlined “in the weeks ahead with the people of California.’’

As a starting point, they cite Trump’s Jan. 20 executive order aimed at beginning the process of dismantling Obamacare. The order states that the federal government should “provide greater flexibility to states and cooperate with them in implementing health care programs.”

Late Thursday night, a spokesman for Gov. Jerry Brown declined to comment on the pending legislation.

One big issue is that the state relies on about $22 billion in federal funding annually to cover private insurance subsidies linked to plans purchased through the state’s health insurance exchange. It also pays for a provision of the law that greatly expanded Medicaid — a health care program for the poor (called Medi-Cal in this state) that is paid for by states and the federal government — to include adults without dependent children. What would happen to those funds is unclear.

But Brown, who decades ago supported switching to a single-payer system, may be able to lean on public opinion for support for a single-payer system.

A Pew Research report last month showed that 60 percent of Americans — up from 51 percent last year — say the government should be responsible for ensuring health care coverage for all Americans, compared with 38 percent who say it should not be the government’s responsibility.

The belief that the government should shoulder that responsibility has particularly spiked among low- and middle-income Republicans, the report said.

Currently, the Pew researchers found, 52 percent of Republicans with family incomes below $30,000 say the federal government has a responsibility to ensure health coverage for all, up from 31 percent last year.

Making the switch to a single-payer system would involve countless moving parts, from negotiating with doctors and hospitals to making major changes in the tax code, said Lawrence Baker, a professor of health research and policy at Stanford.

“While there are certainly ways that single-payer plans can be successful,” Baker said, “there would be lots of things that would have to be worked out.”

Lara is no stranger to health care legislation, especially on behalf of the state’s poor and undocumented.

In 2015, Brown signed into law the senator’s Health4All Kids bill, which allocates almost $280 million in the coming fiscal year to cover health care costs for 185,000 undocumented California children up to age 18.

Last year, Brown also signed a Lara bill that would have allowed undocumented Californians to buy insurance through Covered California, the state’s health insurance exchange, regardless of their immigration status. The legislation would have cost taxpayers little or nothing because the undocumented wouldn’t have been entitled to any government subsidies, and the state filed for a federal waiver under the Affordable Care Act seeking to implement it. But last month, after it was delayed by the Trump administration, Lara withdrew the waiver request.

Anthony Wright, executive director of the nonprofit advocacy group Health Access California, said that his group has supported a number of efforts to put in place a single-payer health care system in California. That included Proposition 186, which voters rejected overwhelmingly in 1994, as well as former state Sen. Sheila Kuehl’s single-payer bills that passed the Legislature in 2006 and 2008 but were vetoed by then-Gov. Arnold Schwarzenegger. Wright’s group also backed a 2012 push for a single-payer health care system by former state Sen. Mark Leno, D-San Francisco.

While he said he was aware of talk surrounding the new bill, he is waiting to see more details.

“California’s health care system is stronger when everyone is included,” Wright said, “and we first need to fight to make sure Congress doesn’t take California further from that goal.’’

Katy Murphy is based in Sacramento and covers state government for The Mercury News and East Bay Times, a beat she took on in January 2017. Before that, she was the news organization's higher education reporter, writing about UC, CSU, community colleges and private colleges. Long ago, she covered Oakland schools and other K-12 education issues.

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